Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis

依西酞普兰 雷波西汀 舍曲林 文拉法辛 西酞普兰 氟西汀 度洛西汀 帕罗西汀 氟伏沙明 安非他酮 米氮平 医学 药理学 心理学 抗抑郁药 内科学 精神科 再摄取抑制剂 焦虑 血清素 替代医学 受体 病理 戒烟
作者
Andrea Cipriani,Toshi A. Furukawa,Georgia Salanti,John Geddes,Julian P. T. Higgins,Rachel Churchill,Norio Watanabe,Atsuo Nakagawa,Ichiro M Omori,Hugh McGuire,Michele Tansella,Corrado Barbui
出处
期刊:The Lancet [Elsevier BV]
卷期号:373 (9665): 746-758 被引量:1617
标识
DOI:10.1016/s0140-6736(09)60046-5
摘要

Conventional meta-analyses have shown inconsistent results for efficacy of second-generation antidepressants. We therefore did a multiple-treatments meta-analysis, which accounts for both direct and indirect comparisons, to assess the effects of 12 new-generation antidepressants on major depression.We systematically reviewed 117 randomised controlled trials (25 928 participants) from 1991 up to Nov 30, 2007, which compared any of the following antidepressants at therapeutic dose range for the acute treatment of unipolar major depression in adults: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine. The main outcomes were the proportion of patients who responded to or dropped out of the allocated treatment. Analysis was done on an intention-to-treat basis.Mirtazapine, escitalopram, venlafaxine, and sertraline were significantly more efficacious than duloxetine (odds ratios [OR] 1.39, 1.33, 1.30 and 1.27, respectively), fluoxetine (1.37, 1.32, 1.28, and 1.25, respectively), fluvoxamine (1.41, 1.35, 1.30, and 1.27, respectively), paroxetine (1.35, 1.30, 1.27, and 1.22, respectively), and reboxetine (2.03, 1.95, 1.89, and 1.85, respectively). Reboxetine was significantly less efficacious than all the other antidepressants tested. Escitalopram and sertraline showed the best profile of acceptability, leading to significantly fewer discontinuations than did duloxetine, fluvoxamine, paroxetine, reboxetine, and venlafaxine.Clinically important differences exist between commonly prescribed antidepressants for both efficacy and acceptability in favour of escitalopram and sertraline. Sertraline might be the best choice when starting treatment for moderate to severe major depression in adults because it has the most favourable balance between benefits, acceptability, and acquisition cost.
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